Breastfeeding Tips
Aim for frequent breastfeeding, whenever baby cues to feed. These smaller, more frequent feedings can be easier to digest.
Try positioning baby in a semi-upright or sitting position when breastfeeding, or recline back so that baby is above and tummy-to-tummy with mom. See this information on upright nursing positions.
For fussy, reluctant feeders, try lots of skin to skin contact, breastfeeding in motion (rocking, walking), in the bath or when baby is sleepy.
Ensure good latch to minimize air swallowing.
Allow baby to completely finish one breast (by waiting until baby pulls off or goes to sleep) before you offer the other. Don't interrupt active suckling just to switch sides. Switching sides too soon or too often can cause excessive spitting up (see Too Much Milk?). For babies who want to breastfeed very frequently, try switching sides every few hours instead of at every feed.
Encourage non-nutritive/comfort sucking at the breast, since non-nutritive sucking reduces irritation and speeds gastric emptying.
Avoid rough or fast movement or unnecessary jostling or handling of your baby right after feeding. Baby may be more comfortable when help upright much of the time. It is often helpful to burp often.
As always, watch your baby and follow his cues to determine what works best to ease the reflux symptoms.
What can I do to minimize spitting up/reflux?
Breastfeed! Reflux is less common in breastfed babies. In addition, breastfed babies with reflux have been shown to have shorter and fewer reflux episodes and less severe reflux at night than formula-fed babies [Heacock 1992]. Breastfeeding is also best for babies with reflux because breastmilk leaves the stomach much faster [Ewer 1994] (so theres less time for it to back up into the esophagus) and is probably less irritating when it does come back up.
The more relaxed your infant is, the less the reflux.
Eliminate all environmental tobacco smoke exposure, as this is a significant contributing factor to reflux.
Reduce or eliminate caffeine. Excessive caffeine in mom's diet can contribute to reflux.
Allergy should be suspected in all infant reflux cases. According to a review article in Pediatrics [Salvatore 2002], up to half of all GERD cases in babies under a year are associated with cows milk protein allergy. The authors note that symptoms can be similar and recommend that pediatricians screen all babies with GERD for cows milk allergy. Allergic babies generally have other symptoms in addition to spitting up.
Positioning:
Reflux is worst when baby lies flat on his back.
Many parents have found that carrying baby in a sling or other baby carrier can be helpful.
Avoid compressing babys abdomen - this can increase reflux and discomfort. Dress baby in loose clothing with loose diaper waistbands; avoid slumped over or bent positions; for example, roll baby on his side rather than lifting legs toward tummy for diaper changes.
Recent research has compared various positions to determine which is best for babies with reflux. Elevating baby's head did not make a significant difference in these studies [Carroll 2002, Secker 2002, Craig 2004], although many moms have found that baby is more comfortable when in an upright position. The positions shown to significantly reduce reflux include lying on the left side and prone (baby on his tummy). Placing the infant in a prone position should only be done when the child is awake and can be continuously monitored. Prone positioning during sleep is almost never recommended due to the increased SIDS risk. [Secker 2002]
Although recent research does not support recommendations to keep baby in a semi-upright position (30° elevation), this remains a common recommendation. Positioning at a 60° elevation in an infant seat or swing has been found to increase reflux compared with the prone (tummy down) position [Carroll 2002, Secker 2002].
As always, experiment to find what works best for your baby.
If your child is taking reflux medications, keep in mind that dosages generally need to be monitored and adjusted frequently as baby grows.
What about thickened feeds?
Baby cereal, added to thicken breastmilk or formula, has been used as a treatment for GER for many years, but its use is controversial.
Does it work? Thickened feeds can reduce spitting up, but studies have not shown a decrease in reflux index scores (i.e., the silent reflux is still present). Per Donna Secker, MS, RD in Gastroesophageal Reflux Disease , "The effect of thickened feedings may be more cosmetic (decreased regurgitation and increased postprandial sleeping) than beneficial." Thickened feeds have been associated with increased coughing after feedings, and may also decrease gastric emptying time and increase reflux episodes and aspiration. Note that rice cereal will not effectively thicken breastmilk due to the amylase (an enzyme that digests carbohydrates) naturally present in the breastmilk.
Is it healthy for baby? If you do thicken feeds, monitor babys intake since baby may take in less milk overall and thus decrease overall nutrient intake. There are a number of reasons to avoid introducing cereal and other solids early. There is evidence that the introduction of rice or gluten-containing cereals before 3 months of age increases baby's risk for type I diabetes. In addition, babies with GERD are more likely to need all their defenses against allergies, respiratory infections and ear infections but studies show that early introduction of solids increases babys risk for all of these conditions.
The breastfeeding relationship: Early introduction of solids is associated with early weaning. Babies with reflux are already at greater risk for fussy nursing behavior, nursing strikes or premature weaning if baby associates reflux discomfort with breastfeeding.
My son suffers with it and has done since birth. It had settled down but now he won't eat much because of it 
and I got a prescription for gaviscon.
